In people with mild cognitive impairment, computerized cognitive training improves cognitive outcomes by a moderate amount immediately after training

Hill NT, Mowszowski L, Naismith SL, et al. Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2016 Nov 14. Epub ahead of print.

Review question

In people with mild cognitive impairment or dementia, does computerized cognitive training improve cognitive abilities or behaviour?

Background

Mild cognitive impairment includes problems with thinking, memory, language, and decision-making that are noticeable but usually don’t affect daily living. Dementia is cognitive impairment that is serious enough to interfere with everyday living activities.

Computerized cognitive training has people do mentally challenging tasks on a computer, allowing them to practice their cognitive skills. It is believed that cognitive training may reduce the risk of worsening cognitive function over time.

How the review was done

The researchers did a systematic review, searching for studies published to July 2016. They found 25 randomized controlled trials (29 treatment comparisons) with 686 people with mild cognitive impairment and 389 people with dementia (average age 60 years or older, 52% to 64% women).

The key features of the trials were:

• people had mild cognitive impairment or dementia;
• computerized cognitive training was done on a computer using drill and practice of cognitive skills, videogames, or virtual reality;
• training was mostly supervised, done for at least 4 hours, and most people had between 6 and 36 hours of training;
• computerized cognitive training was compared with no training, sham training, a different intervention (e.g., psychoeducation), or pencil-and-paper training; and
• most outcomes were measured immediately after training was completed.

What the researchers found

Immediately after training in people with mild cognitive impairment, computerized cognitive training:

• improved working memory by a large amount;
• improved overall cognitive outcomes, global cognitive ability, attention, psychosocial functioning, verbal memory, verbal learning, and nonverbal learning by a moderate amount; and
• did not change nonverbal memory, visuospatial skills, executive function (problem-solving, judgment, and decision-making), processing speed, language, or activities of daily living.

Immediately after training in people with dementia, computerized cognitive training:

• improved visuospatial skills by a moderate amount;
• improved overall cognitive outcomes by a small amount; and
• did not change any other cognitive outcomes.

Only 1 trial in people with mild cognitive impairment showed that cognitive outcomes were still improved at 12 weeks after training was complete.

Conclusions

In people with mild cognitive impairment, computerized cognitive training improves overall cognitive outcomes by a moderate amount immediately after training. In people with dementia, computerized cognitive training improves few cognitive outcomes.

Computerized cognitive training vs control* in older people with mild cognitive impairment or dementia

*Control = no training, sham training, a different intervention (e.g., psychoeducation), or pencil-and-paper training.

†Based on standardized mean differences (SMD) measured immediately after training: small effect = less than 0.3 SMD, moderate effect = 0.3 to 0.59 SMD, large effect = 0.6 or more SMD.